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(SAMPLE LETTER TO REQUEST PLAN DOCUMENTS)

[Date] VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED Plan Administrator Human Resources Department [Name of Employer] [Address] RE: Claimant/Insured Plan Name Control/Group No. Dear Plan Administrator: I write regarding the denial/termination of [Short or Long] -Term Disability benefits dated [date]. Pursuant to 29 U.S.C.A. 1024(b)(4), please forward me a copy of the Trust Document (commonly known as the Plan Document), Summary Plan Description (SPD), and Form 5500 in effect as of [ date ] (the date of my disability). Please also forward any amendments to the Trust Document, SPD, and Form 5500 from [date of disability] through the present. As the Plan Administrator of the [name of plan ], you have a fiduciary duty to ensure that these documents are sent to me. I await your prompt reply. Thank you for your assistance in this matter. Very truly yours, : [your name] :[ ] :[ ]

[your name]

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